How an Online Interview Can Help Programs Monitor Patient Progress, Identify Problems

Patients in treatment for opioid use disorder (OUD) may have other conditions that need treatment, and ignoring them can lead to relapse. An online assessment system devised by Norman G. Hoffmann, Ph.D., who is a leading expert in devising questionnaires to help programs assess patients, explained to AT Forum as we attended the Cape Cod Symposium on Addictive Disorder (CCSAD) how the CAAPE-5 (Comprehensive Addiction and Psychological Evaluation-5) could be used by opioid treatment programs (OTPs).

The CAAPE-5 takes 35-45 minutes to administer. Patients can answer the questions themselves, under supervision, via a mouse or touch screen tablet.

“OTP programs would use the CAAPE-5 to routinely cover other substance use disorders and commonly co-occurring conditions that could interfere with the OTP,” said Dr. Hoffmann, who is president of Evince Clinical Assessments and founder of Evince Diagnostics, LLC. “Conditions such as PTSD [posttraumatic stress disorder] and major depression can pose risks for dropping out of the OTP or otherwise jeopardize positive progress.

Dr. Hoffmann has been developing assessment tools since the paper and pencil days. Executive director and founder of the Minnesota-based Comprehensive Assessment and Treatment Outcome Research (CATOR) center, which conducted follow-ups on addiction treatment patients as well as other projects, Dr. Hoffmann has developed online assessments.

“The advantage of the online assessments is that anyone can administer the interview,” said Dr. Hoffmann, who with his son, Tyson, technical director of Evince Diagnostics, presented the assessments from his booth at CCSAD. The CAAPE-5 is on a HIPAA-compliant website which drives the presentation of questions and does any necessary branching,” said Dr. Hoffmann. “A report of findings is available immediately as a PDF file, which can be printed and/or inserted into an electronic record.”

Costs of the assessment range based on order size, but are from $5.90 to $6.75 for one CAAPE-5. For the price of a fancy cup of coffee, you can get a standardized assessment of behavioral health conditions that may impact outcomes for opioid treatment.

Definition: The CAAPE-5 is a comprehensive interview that documents substance-specific and common mental health conditions based on the DSM-5. It also informs three dimensions of the ASAM criteria.

This means the instrument works well with American Psychiatric Association criteria for diagnosis, and ASAM criteria for patient placement.

Other Evince Assessment tools:

  • SUDDS-5 (Substance Use Disorders Diagnostic Schedule): a comprehensive interview that provides detailed documentation of substance-specific DSM-5 diagnostic indications plus age of onset for problems that may support motivational enhancement.
  • TAAD-5 (Triage Assessment for Addictive Disorders): The TAAD-5 is a brief structured interview designed to identify current alcohol and drug problems.
  • PADDI-5 (Practice Adolescent Dual Diagnostic Interview): The PADDI-5 is a comprehensive interview based on the DSM-5 for identifying co-occurring mental health and substance use disorders among adolescents.

Assessing jail inmates

A recent study by Hoffmann found a high prevalence – 93% — of substance use disorders in a Florida jail.

Using the CAAPE-5, Hoffmann evaluated a sample of inmates of the Franklin County, Florida detention center. The interviews took place between August 2019 and October 2020. A total of 99 male and 46 female detainees were evaluated.

Among recently booked inmates, there was a high prevalence of drug injecting and severe stimulant use disorder. Patients with OUD have increasingly had co-occurring stimulant disorders as illicit fentanyl, for a variety of reasons, has been combined with methamphetamine. Key findings from the report:

  • 93% had at least one substance use disorder (i.e. mild, moderate, or severe)
  • 70% had at least one severe substance use disorder
  • 30% had multiple severe substance use disorders
  • 62% had a moderate to severe methamphetamine diagnosis
  • 13% had a moderate to severe opioid diagnosis
  • 37% had a moderate to severe alcohol diagnosis
  • 48% of the inmates had injected any drug in the past 12 months
  • 34% reported injecting methamphetamine on numerous occasions

The most common mental health conditions identified were PTSD and major depression. “Previous research suggests these conditions require special attention because those with both PTSD and panic attacks may be more likely to have been charged with a violent offense,” according to the report.

Below are the most prevalent mental health conditions among this jail population:

  • 55% had indications of possible PTSD
  • 49% reported a major depressive disorder in the past 12 months
  • 29% of the inmates suffered from panic attacks
  • 25% reported indications of both PTSD and panic attacks
  • 26% of inmates reported manic episodes
  • 21% reported a possible indication of a bipolar disorder
  • 33% met criteria for an antisocial personality disorder (ASPD)
  • 56% had indications of multiple mental health conditions.

Clearly, conditions such as the above, if untreated, would complicate any SUD treatment. And OTPs are already well aware of the growing rise of stimulant use disorders. Alcohol use is a complicating factor in treatment with methadone and buprenorphine, as well, as it is a central nervous system depressant.

In another study conducted in a North Carolina jail, alcohol use disorder was prevalent, although not as severe as stimulant and opioid.

For a list of peer-reviewed publications on the CAAPE, go to https://evincediagnostics.com/blog/peer-reviewed-publications-research-publications

For more information, including sample test reports and more, contact norman@evincediagnostics.com (401)374-0375. For technical assistance, contact tyson@evincediagnostics.com (630)835-5715).

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